24 Tools No Doctor Should Be Without

Modern physicians have a vast array of tools and information at their disposal that can help them deliver better care to their patients, run their practices more efficiently, and stay up to date with the latest research. In fact, there are so many tools available that it can be next to impossible to sort through them all and determine which ones are truly the most useful. We consulted several MDNG editorial board members to determine which tools and resources they rely on and compiled this list of the top tools every physician should at least be familiar with, if not use in his or her everyday practice. According to Frank Freemon, MD, neurologist, “The right tools can make an expert out of an otherwise ordinary guy.”

For the Office

1. Office Desktop Computer. If you don’t use a computer in your home or practice, you likely can’t make much use of this article—most of the tools discussed herein require a Mac or PC. Having said that, if you’re looking to upgrade your current system we recommend a custom-made PC from Dell or similar retailer, or an Apple iMac. Although the majority of EHR, EMR, and other health IT programs are Microsoft Windows-based, Mac users can now run Windows software.

2. Affordable and Easy-to-Use EHR System. According to MDNG Physician Editor-in-Chief Jonathan M. Bertman, MD, EHR systems “that aren’t affordable and/or easy-to-learn are actually the #1 tool a doctor should avoid at all costs!” We recommend checking out Dr. Bertman's own AmazingCharts and SOAPware.

3. ePocrates Online. This free drug and formulary reference offers access to more than 3,300 brand and generic drug monographs, with coverage including both on- and off-label dosing, pricing, adverse reactions, contraindications, mechanism of action, and drug interactions. Also included are integrated health insurance formularies, print and e-mail functions, explanations of medical abbreviations, and a multiple-drug interaction checker. Learn more at www.epocrates.com/products/online.

4. Micromedex. Delivering “clinical knowledge solutions” through any combination of integration options, an intranet, the Internet, a PDA, a network, or a stand-alone CD-ROM, Micromedex offers “answers to questions for both common and uncommon conditions that can be accessed either during or immediately after patient encounters.” Evidence-based references and tools cover disease states, treatment guidelines, medications and toxicology, and patient education.

5. UpToDate. Providing evidence-based information via the Internet, CD-ROM, or Pocket PC, UpToDate is designed for use at the point of care, providing concise, fully referenced topic reviews from nearly 3,000 clinicians. Specialty-specific information covers many disorders in regards to diagnosis, management and therapy, and optimal screening and prevention. Plus, UpToDate automatically tracks its offered CME credits.

6. MedlinePlus. Direct your patients to this comprehensive online resource from the US National Library of Medicine and the National Institutes of Health. Medline Plus offers extensive coverage of more than 700 disease and wellness topics; information about both prescription and over-the-counter medicines; a medical encyclopedia with pictures and diagrams; a medical dictionary; the latest news; directories; and links to other resources.

7. E-Communication With Patients. In 2005, Shou Ling Leong, MD, and colleagues from Penn State College of Medicine studied four physicians who offered to their patients the option of communicating via e-mail and four physicians who did not. They found that e-mail communication was more convenient and more satisfying for both the patients and their physicians, and e-mail didn’t increase the volume of messages or time spent answering them, compared with standard means of communication. Leading the way in secure e-mail communication services are RelayHealth and Medem, Inc. Plus, many EHR vendors include a communication portal, such as Epic System’s MyChart and AboutMyHealth from GE Medical Systems.

8. Exam or Consultation Room Computers. Be it a desktop, laptop, tablet, or handheld, a computer in the exam or consultation room allows the physician, as well as his or her support staff, to access virtually any needed information—depending on capabilities and implemented software—at the point of care. Among the best laptops are the the ThinkPad X60 and the Apple Macbook. Top handhelds include the Palm TX and the Dell Axim X51v. The Asus R1F and Fujitsu LifeBook T4215 Notebook are two of the most popular tablet PCs.

9. NexCura Professional Tool. The NexCura Professional Tool is a free, comprehensive search tool that “provides fast access to a database of evidence-based clinical literature selected and reviewed by physicians on [NexCura’s] medical Editorial Boards, who are recognized experts and leaders in their respective specialties.” Searches for studies relevant to an individual patient’s clinical presentation are narrowed to those that only define the current standard of care. Using NexCura’s Virtual Case Model (VCM), physicians can search for relevant published literature by describing search parameters based on clinical presentations, such as age, performance status, stage, and test results.

10. MD Consult. Users of this online service include more than 90% of North American medical schools and more than 1,700 healthcare organizations in 46 countries. MD Consult brings together 51 top medical reference books, 80 medical journals and clinics, MEDLINE, more than 1,000 peer-reviewed clinical practice guidelines, comprehensive drug information, online CME, more than 9,000 patient education handouts, and personalized daily clinical updates. Features include weekly case presentations, clinical topic tours, and reviews of “hot topics.”

11. Cochrane Library. Available by subscription, this online evidence-based medicine resource (http://thecochranelibrary.com; also available as a CD-ROM) is published four times yearly and “contains high-quality, independent evidence to inform healthcare decision-making” through “reliable evidence from Cochrane and other systematic reviews, clinical trials, and more.” The Cochrane Reviews that make up the bulk of Library content “explore the evidence for and against the effectiveness and appropriateness of treatments (medications, surgery, education, etc) in specific circumstances.” Physicians who visit their nearest medical library should be able to take the Cochrane Library for a test drive before committing to a subscription.

12. Ovid. Access a growing list of 1,200 top journals, more than 500 texts, and more than 200 databases with this tool that offers innovative information search and discovery and customized services, complete with 24/7, award-winning technical support. Search electronic versions of highly regarded books from cover to cover, “one of the largest single-database aggregations of 100% searchable scientific, technical and medical full text journals in the world,” clinical decision support tools, and premium mixes of Ovid content and tools tailored to specific subjects. Check it out at www.ovid.com/site/index.jsp.

13. Screen OCR. Can’t copy the text from an online resource you’d like to copy for yourself or a patient? Capture any text on your computer screen (even in graphics format), and convert it to text with this screen capture and character recognition tool that saves and recognizes everything you see, be it an image, scanned text, a .PDF, or page presented in HTML format. Users simply choose a selection mode, select the data, and copy it to the clipboard and then integrate into any word processing program. Download a free, 21-day sample at www.screenocr.com.

14. The ICD-9-CM Online Database. Find every code you need with this database, compiled from files available from the National Center of Health Statistics and including tabular and alphabetic indexes for classification of disease and injuries and classification of procedures, as well as a table of drugs and chemicals and an alphabetic index to external causes. You’ll definitely want to add this one to your favorites list: http://icd9cm.chrisendres.com.

15. PubMed. If it’s been published in a clinical journal and you don’t find it here, then you likely won’t find it anywhere. PubMed, a service of the National Library of Medicine and the National Institutes of Health, provides access to an enormous database of “bibliographic citations and author abstracts from more than 5,000 biomedical journals published in the United States and 80 other countries.”

16. .Mac Account. Synchronize, back up, and share files, and publish your own webpage with a .Mac account. For about $100 per year (try for free for 60 days), a .Mac account includes the easy-to-use iWeb website publishing tool; iDisk for exchanging files and centralizing documents for access anywhere; .MacSync for synchronizing key information wherever you go; member benefits that include free software downloads; Photocasting for sharing full-quality iPhoto albums with friends and family; and .MacMail, an ad-free, virus-protected e-mail service with 1GB of storage that’s compatible with Macs and PCs.

17. Google Desktop. Search your e-mail, files, music, photos, chats, Gmail (Google’s e-mail service), web sites you’ve visited, and more with this desktop application, that’s so much more than just a desktop search tool. Use the application’s desktop sidebar for “at-a-glance” personalize information, including such Google Gadgets as a calendar, sports scores, weather, to-do lists, and various games. Also available through the free service, Google Docs & Spreadsheets “is a free Web-based word processing and spreadsheet program that keeps documents current and lets the people you choose update files from their own computers.” Do it all anywhere you go from any computer with Internet access.

18. OnCall Scheduling System. Create and fine-tune your schedules with this online tool, and then view them online, page staff, e-mail personal calendars, and field special requests at amion.com, what one of our editorial board members calls “simply the best way to maintain call schedules online.” For $249 per year, OnCall enables users to enter their work preferences and request and then delivers “fair, error-free results” consisting of listings of who’s available for each call, shift, and clinic slot.

For the Home Office

More and more, physicians are unable to keep a work/home balance, with work following them home. Therefore, we offer the following recommendations for technology to add to your home, thanks to editorial board member Eric G. Tangalos, MD, FACP, AGSF, CMD.

19. Wireless Internet Network w. Signal Booster. Most Internet service providers now offer wireless service, allowing you to check your e-mail, plan a vacation, and buy that rare Beanie Baby you’ve had your eye on at eBay while sitting on the couch, at the kitchen table, or on “the throne.” Contact your provider for details on how to go wireless at home if you haven’t done so already. For those looking to go it alone, it seems that Linksys provides the most popular routers. Wireless Internet isn’t perfect, and some users may experience “cold” spots in their home, where wireless penetration is poor; as a solution, we suggest a booster (AKA range extender/expander), which can plug right into the wall after training it to the base signal (much like you would a garage door opener). Not only will you likely get coverage throughout your house, you could see an increase in speed!

20. 5.8GHz Phone(s). Upgrading to a 5.8GHz cordless phone (especially worthwhile for persons using 2.4GHz phones, as they use the same frequency most commonly used for wireless internet) will provide users with cell phone-like memory and phone books, as well as an in-house intercom and base stations that serve as answering machines. Enjoy security, clarity, and long range, as 5.8GHz phones offer less traffic than traditional 2.4GHz phones. We recommend the Panasonic KX-TG5673PK, which comes with a three-handset system featuring one base unit and two chargers, a digital answering system, and talking caller ID that tells you who’s calling without ever having to walk away from your work…or play.

For When You’re on the Go

21. PDA. “In the near future, a physician will no longer consider seeing patients without a handheld device (PDA) any more than seeing them without a stethoscope,” said Dr. Joseph Pisegna in 2003, Associate Professor at UCLA and Chief of Gastroenterology and Hepatology of the VA (Los Angeles). “Mobile computing will take the guesswork out of medicine, reduce errors, and enable the physician to spend more time interacting with the patient.” How right Dr. Pisegna was. If you don’t have a handheld device by now, then you’re far behind your colleagues…but hope exists. (If you do have a PDA and are looking to upgrade, skip to the next paragraph.) For the rest of you, a PDA can provide access to most, if not all, of the files on your office and/or home computer, e-mail, the Internet, and more while at home, in the car, at the office, at the airport, or sitting on the beach in St. Lucia (you docs just don’t know how to leave your work behind, do you?). Although major differences used to exist between the two main PDA operating systems (Palm OS for Palm PDAs, and Windows Mobile for Pocket PCs) in terms of functionality, ease of use, and cost, the two have recently become quite equal in their abilities, and thus it’s really up to each individual to decide which PDA type is best for him or her. PDAs receiving the best reviews are the Palm TX, Dell Axim X51v, and the Palm Tungsten E2. Refer to the PDA Resources section in every print edition of MDNG or its replication at mdng.com for the must-have software for your newly acquired, or old, PDA.

22. Bluetooth Hands-free Car Link. Take hands-free calling to the next step with a Bluetooth hands-free car link that allows users to dial and receive mobile phone calls without taking their hands off the wheel or wearing one of those goofy headsets. More and more cars are now coming equipped with the technology, but aftermarket devices that clip onto a sun visor, such as the SuperTooth II; are built into a rearview mirror, like the ModooFree BT; and plug into a cigarette lighter, including the Nokia Wireless Plug-in Hands-free HF-6W can be purchased for use with many phones. You’ll definitely want to check the compatibility of a device with your phone before taking the plunge. Now you have no excuse for not taking calls from the office while in the car.

23. Laptop/Notebook/Tablet Computer. By now, just about everybody knows what a laptop—or any variation thereof (ie, notebook or tablet)—is, and that they allow users to bring most of the functionality of a desktop computer with them wherever they go, with battery life as really the only limit. Although laptop and notebook are used interchangeably, tablets add the use of a touch screen that allows users to operate the computer with a stylus, digital pen, or fingertip, as opposed to a keyboard and mouse. The use of each of the above in healthcare may not be so well known; physicians can enter information into a patient’s EMR and e-mail a prescription to the pharmacy while in the exam room, refer to lab results while on the couch in their living room, or write and edit their latest submission to MDNG (e-mail us for information on how to do this) while on the train.

24. Broadband PC Card. Now that you’re on the go with your spiffy new laptop, you’ll need Internet access. Sprint, Verizon Wireless, and Sierra Wireless are among the top companies now offering these devices, which provide users of laptop and notebook/tablet computers with type II PC card slots or USB drives with wide-area network (WAN) wireless Internet, and therefore e-mail, access wherever he or she may travel. Check patient records, refer to the latest treatment guidelines online, or send a patient an e-mail from your seat at a conference in Cleveland or poolside in the Cayman Islands.